Application

A Welcoming Wiccan Community

Coven Application Request

Your Real Name *

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Last

Your Craft Name (if you have one) *

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Last

Email *

Address *

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City

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Zip Code

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Phone Number *

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Date of Birth (mm/dd/yyyy) *

How did you hear about this site? *

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If Other please specify: *

What is your household income? *

Less than $10,000 $10,001 - $25,000 $25,001 - $40,000 $40,001 - $70,000 $70,001 - $100,000 Greater than $100,000 Prefer not to say

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